July 2010 Archives

Work and pensions secretary Iain Duncan-Smith has unveiled his heavily trailed welfare reform paper: 21st Century Welfare.

The thrust of the consultation paper is the ethos that work always pays and should be clearly seen to pay, At the same time it claims to be able to bring an end to the department's perennial quest to simplify the welfare system.

It is difficult to work out the impact on the most vulnerable. The paper insists there will be protection for this client group and adds: "We do not aim to reduce the levels of support for people in the most vulnerable circumstances but it is clearly important that we ensure support is well targeted, is fair to those on low pay and that the right money goes to the right people."

It goes on to say: "It would not, however, be our intention to use Universal Credit reform to reduce the levels of support for people in the most vulnerable circumstances. At the appropriate stage, we will assess the impact of our proposals on vulnerable groups."

The reforms include allowing people to keep more of what they earn as they move into work whilst withdrawing benefits at a single, more reasonable rate as people start to earn more money.

The options in the document could see a major reform of the number and type of tax credits and benefits available and the way in which they are withdrawn when people move and progress in the workplace. They would:

    * Combine elements of the current income-related benefits and Tax Credit systems;
    * Bring out-of-work and in-work support together in a far simpler system.
    * Supplement monthly household earnings through credit payments reflecting circumstances (including children, housing and disability).

The system could improve incentives to get a job as people would see no reduction in their benefit until they earn over a certain level.

It is also designed to cut the amount of fraud and error in the system and also lessen the amount of time customers need to spend filling out forms when a job ends.

These elements have Duncan-Smith's fingerprints all over them. He clearly believes very much in the morality of work but at the same time has a strong social welfare instinct and was the man who set up the Centre for Social Justice

The main news out today will be the forthcoming welfare reform proposals.

Various options will be laid out at about 11am this morning by work and pensions secretary Iain Duncan Smith.

One of the ideas appears to be combining income support and housing benefit with the tax credit system. We'll find out later, though I suspect whatever is proposed won't be welcomed.

Beyond that there's a lot of dementia-related news doing the rounds.

Among these if you're a poor sleeper who kicks and lashes out while asleep, it could be a sign that you could develop the condition in later years, say scientists.

Meanwhile researchers at Abertay University, Dundee are to investigate whether speaking in more than one dialect could protect older protect people from developing dementia.

Also on dementia, Lincolnshire has published its first dementia care strategy, though concerns over how this can be delivered at a time of efficiency savings are being raised. Similarly Lothian has also just published its new strategy.

The government wants to "refresh" its predecessor's 10-year national carers strategy. Launched in 2008, the strategy aims to ensure carers receive personalised support and have a fulfilling life outside caring. Care services minister Paul Burstow says he agrees with the strategy's aims but needs to set priorities for implementation from 2011-15. The government is consulting on its "refresh" until 20 September. It has also, helpfully, produced a few health warnings for respondents:-

• The review will not cover benefits, which will be considered separately. It's worth noting that as part of the carers strategy, the Labour government promised a review of carers benefits but failed to provide a timescale. It never happened, to the great disappointment of carers groups who have long argued that current provision (notably the £53.90 a week carer's allowance) is woefully inadequate.
• The public spending situation (i.e. cuts of 25% to 33% for social care from 2011-15) means "trade-offs" will be required between the strategy's various goals.
  

An action plan will be published before the end of the year. Get your views in quick.

Fighting Monsters has a good blog out today on a reported dip in public sector productivity in 2008.

According to The Guardian report on the Office for National Statistic's review, the worst offenders are those in adult social care.

The productivity measure used by the ONS sets outputs of public services, such as NHS operations and GCSE grades, against inputs of labour, materials and capital assets.

As both the Guardian and the ONS point out this makes no allowance for quality of care services, rising levels of need or the growing numbers of people receiving support at home.

This is the same point made by Fighting Monsters.

However it's almost certain to be used by the coalition government as ammunition to justify spending cutbacks leading to an even smaller state.

The funding formula for the preserved rights grant will not be changing but allocations will be based upon much more up to date figures on client numbers (these are people who were in residential care and funded by income support prior to 1993 when they became councils' responsibility). This means large shifts in funding for some authorities (Lancashire would see its funding slashed from £4.9m to £2.3m a year for instance).

The Aids support grant (which funds social care for people with HIV/Aids) will be based on 2008 figures for client numbers for the rest of the spending review period (up to 2015). This risks leaving councils vulnerable to shifts in client numbers.

With the learning disability commissioning transfer grant (I can barely type it!), this refers to money currently allocated by DH to PCTs to fund social care; in 2009-10 and 2010-11 PCTs have transferred this money (about £1.3bn) to local authorities; from 2011-12 local authorities will receive it directly. The consultation says this will be based on money transferred from PCTs to councils in 2010-11 rather than a needs-based formula. This is good on the one hand in so far as it means authorities won't see shifts in funding; on the other there have been concerns expressed in the past that the amount PCTs have transferred wouldn't be sufficient to meet need.

One caveat worth mentioning is that the coming comprehensive spending review may abolish all these grants (even the one with the long name that doesn't exist yet).

The Department for Work and Pensions has issued a call for evidence into the work capability assessment.

The WCA forms an important part of the Employment and Support Allowance claim process, and is designed to determine which claimants are capable of undertaking work, or work-related activity.

However it has been dogged by controversy over the numbers of people wrongly found fit for work and last month the government announced a review into its operation to be carried out by Professor Malcolm Harrington.

He now wants to hear from organisations and individuals on the WCA.

Related to this Mind has announced that its chief executive Paul Farmer has joined a scrutiny group to advise and challenge the WCA review.

Yesterday the DWP yesterday released the latest statistics for Employment and Support Allowance (ESA) applications, which show that 39% of applicants are being found fit for work following their assessment.

However 40% of decisions are overturned on appeal.
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I'll start off today's round-up with reaction to the breaking news from yesterday that the General Social Care Council is to be abolished.

It's clear that people are still digesting the announcement, which came as a shock to many.

Yes it had not had a great start, but it was starting to turn the corner.

The Fighting Monsters blog reflects the feeling that I guess is common among many in the sector, which is to give the sector more time to allow an idea to bed down before making a judgement.

The blog expresses a concern that this could mean that the aim of registering all social care workers has now gone down the pan.

I found this amusing list of further ways you know you are a social worker.

Enjoy.

Housing benefit claimants living in central London are likely to have to move as a result of the government's planned welfare changes, the government has itself admitted.

This frank admission is contained in the Department for Work and Pensions' equality impact assessment into its housing benefit changes, which it published today.

To remind people here are the changes.

From April 2011:
•
the removal of the five bedroom Local Housing Allowance rate so that the maximum level is for a four bedroom property
•
the introduction of absolute caps so that Local Housing Allowance weekly rates cannot exceed:

£250 for a one bedroom property
£290 for a two bedroom property
£340 for a three bedroom property
£400 for a four bedroom property

From October 2011:

Local Housing Allowance rates will be set at the 30th percentile of rents in each Broad Rental Market Area rather than the median.

Additionally, from 1 April 2011, the £15 weekly Housing Benefit excess that some customers can receive under the Local Housing Allowance arrangements will be removed.

Just come across this story, which underscores why staff do not trust outsourcing: Care home workers' £1m compensation.

I've come across a lot more cuts stories today, indicating that the government's austerity drive is really beginning to bite and to hit our sector.

Among these the St Helen's Star reports that £500,000 is being slashed from the adult social care budget; the Streatham Guardian reports fears for elderly services in Lambeth; while Sandwell College in Halesowen has cut its budget for providing education services for those with learning disabilities.

The Department of Health has published two new consultation documents today relating to the health White Paper, Equity and excellence: Liberating the NHS:

      Commissioning for Patients; and
      Local Democratic Legitimacy in Health.

Reading the two together I could not help but think that there is the potential for disaster and more and more it feels like the triumph of ideology over common sense.

Implicit within it is a wholescale privatisation of the NHS, with the line: "Over time a more competitive market will develop for supplying some of these [commissioning support] services."

There also appear to be question marks raised over current joint working arrangements despite reassurances from health secretary Andrew Lansley.

Commissioning for Patients says that care trusts that bring together health and social care services will see their healthcare responsibilities transferred to GP consortia.

Interestingly consortia will be statutory public bodies but there will be no "Whitehall blueprint for the geography of consortia".

This raises further questions over joint working and over integrated working because it implies that there may not be co-terminosity between GP consortia boundaries and local authority boundaries. 

The big news for our sector today is the formation of the Commission on Long Term Care.

In other news, a man with locked-in syndrome has demanded the right to die

Tony Nicklinson, a 54-year-old engineering executive, who suffered a massive stroke and lives "locked-in", able only to move his head and eyes, has launched a legal attempt to allow his wife to kill him.

The problems for older people living with HIV has rarely been acknowledged, but according to '50 Plus', the first national study of ageing and HIV, and launched tomorrow in Vienna at AIDS 2010, the 18th International AIDS Conference, they have worse health. are poorer and fear for the future.

At present there a quite a lot of social care services which are provided by the voluntary sector. Hospices are reliant on volunteers, peers support groups can't work without them and countless third sector service use volunteers as part of their staff. Is that a model that can be expanded or, while many struggle to keep their jobs and provide for their families in the age of austerity, is it a bit hopeful to expect more people to give up their time to help others?

I think it's probably the latter I certainly can't see it beginning to plug the gap in care provision which is already a problem employers find it difficult to get good staff to solve when they're getting paid. What do you think?

The Department of Health has today published a fascinating survey of investment in adult mental health services.

The survey shows a picture of ever increasing investment in services for working age adults from 2001/02 to 2009/10, which I suppose can be termed the time of plenty for the NHS.

I'm not sure that staff working in these services would have recognised this as the time of plenty but since 2001/02, the real term total investment, after allowing for inflation, has increased to £6.311 billion in 2009 /10 from £3.996 billion 2001/02.

This represents an increase of 58% in real terms after allowing for inflation. Considering that mental health services have tended to be the poor relation compared to the acute sector this must represent an achievement of sorts.

However now we are in an era of cutbacks and I fear -and many others within the sector fear - that mental health services will take the brunt of any cutbacks and I suspect that once the spending cuts bite within the NHS we will see investment falling.

There may be some guarding against this if the move towards a payment by results system within mental health services, as highlighted in the health White Paper, goes ahead.

With unemployment heading for three million and an agenda to cut the welfare budget we have all heard about the coalition government's plans to tighten up eligibility conditions for claimants.

Here is a good feature on what's going on.

Following on from Mithran's blog post yesterday about growing pessimism about the health White Paper, The Guardian has posted a comment piece that the paper is little more than a wholesale privatisation of the NHS.

Seamus Milne warns that if the plans are taken to their logical conclusion, by 2015 the NHS will be little more than a brand commissioning services from a string of private companies in a fully-fledged healthcare market with dangers to the most vulnerable.

He describes it as a "triumph of ideology over common sense and public opinion".

It's worth reading: We cannot allow the end of the NHS in all but name.

To follow Jeremy's blog post yesterday, there is yet more pessimism about the health White Paper, this time from social work blogger Fighting Monsters. She fears that the injection of market principles into the NHS will mean it will go the way of the community care reforms to social care in, in her words, driving down costs and limiting choice. Well worth a read.

I found a fascinating blog on Health Policy Insight on why the health White Paper will all end in tears.

It's so good it's worth sharing.

Ten reasons why the White Paper will all end in tears.

For our sector the most interesting of the stories out there is the story of a paralysed man who blinked just as his life support machine was to be turned off.

The story of Richard Rudd, who has a condition called locked-in syndrome has reopened the pitfalls surrounding living wills. 

The condition means he can not move his limbs or speak, though he can think, hear and feel.

His story is across most of today's papers:

Paralysed man blinked to stay alive as life support machine was about to be turned off

Man used eyes to show will to live

Blink, and you live - doctors' message to man in a coma

Richard Rudd blinked to save his own life

Clearly the main item today is looking ahead to publication of a health white paper that will put responsibility for commissioning services in England in the hands of GPs.

The proposal is radical and makes some sense because it puts power in the hands of those closest to patients - the clinicians - but there are concerns that the plans could set the NHS back by three years.

So among a selection:

GPs 'to get control of NHS funds' in England

Tories set out plans for 'results-driven NHS

Health reform sparks fears of cuts by stealth

Of course in saying I think it's a decent idea I'm ignoring the fact that passing the assessment to get onto ESA doesn't necessarily mean you're fit for work.

Do you agree, or is this bonkers?

The main story doing the rounds today is news that the government is set to press ahead with plans to hand responsibility for most health services to GPs.

It appears likely that a health white paper will be published next week, some say Monday, outlining how the government intends this to work.

The white paper will also outline how the public health service will work.

For our sector questions remain around how groups of GP consortia will interact with local authorities, which have built up good working relations with primary care trusts and how they will handle the big strategic health and social care issues, such as re-ablement for instance as well as areas such as mental health and learning disability.

A new report out today has found that the numbers of murders committed by people with mental health problems has fallen while the number of suicides by mental health patients has also decreased.

It also suggests that a previous rise in homicides by mentally ill people may have been the result of drug or alcohol misuse.

Early signs of the problems the coalition government is going to have to face down is becoming apparent among our selected stories today.

The Guardian reports Labour claims that its numbers are being swelled by 1,000 a week by activists committed to opposing the Tory and Lib Dem coalition.

Interestingly Labour is making the claim that many of this new breed are in particular opposed to the Lib Dem leadership having brokered a deal with the Tories, which underlines the difficulties Lib Dem leader Nick Clegg is going to have in keeping his party together.

The Building and Social Housing Foundation has produced an excellent paper looking at the possible effects of the government's planned changes to housing benefit.

Among noteworthy comments the paper refers to the danger of creating Parisian-style banlieues - areas of deprivation on the outskirts of city while the city centre has become exclusively for the well-off.

It says: "The potential for the total exclusion of the poor from large areas is clearly present in the measures announced in the budget."

It is probably very easy to damn the government as the same old Tories looking to slash and burn, but the report also points out that the "UK's system of providing support with housing costs warrants significant attention, both to ensure that it is meeting housing need and that the long-term cost is managed."

However it does say that linking worklessness and cuts in housing benefits "risks an increase in the incidence of homelessness presentations, creating a greater impact on public expenditure in the medium term."

Click here to read the report.